I covered this back in December when the Centers for Medicare and Medicaid Services (CMS) released final enrollment numbers for the 39 states which use the federal exchange. But as I noted at the time, some states with their own exchanges had extended deadlines which meant the real final tally wouldn’t be in until February. Today, California released its final results and that allowed the Associated Press to release a new tally. The AP finds that enrollment nationwide is down just 3% compared to last year:
Nearly 11.8 million Americans have signed up for coverage this year under former President Barack Obama’s health care law, about 3 percent less than last year, according to a new tally by The Associated Press.
Enrollment remained remarkably stable despite President Donald Trump’s disdain for “Obamacare,” and repeated efforts by the Republican-led Congress to repeal the program. The Trump administration also cut the sign-up window in half, slashed the ad budget, and suddenly stopped a major subsidy to insurers, which triggered a jump in premiums.
“If you had asked me a year ago whether enrollment for 2018 would be almost equal to 2017, I would have laughed at you,” said Larry Levitt, who follows health law for the nonpartisan Kaiser Family Foundation. “So long as lots of people are still getting insurance it becomes much harder to take that away.”
Larry Levitt is about as reliable a supporter of Obamacare as one could find. He’s non-partisan on this issue the way the DNC is non-partisan on it. That aside, he’s right that few people, including me, thought enrollment would be this close to last year. But I would take issue with his statement that “So long as lots of people are still getting insurance…” it’s hard to take away. Actually, it would be closer to the truth to say ‘The longer people are getting heavily subsidized or free insurance, they’ll grow accustomed to that.’ Because most of the people who enrolled via the exchange are people getting a significant break thanks to the subsidies. Why wouldn’t they stick with the program? Someone else is paying most of the cost of their insurance. From their perspective, what’s not to like?
Charles Gaba, who has been tracking enrollment at his ACASignups blog, says the numbers would have been even higher but some states were actually encouraging unsubsidized people to move off the exchange:
I was a bit disappointed to discover that instead of beating out last year slightly, they ended up coming about 2.3% short year over year…but there’s a very good reason for that: Like Maryland, California not only utilized the full “Silver Switcharoo” strategy with individual market premiums, they actively encouraged current UNSUBSIDIZED on-exchange Silver enrollees to switch to off-exchange Silver plans instead.
This is a difficult thing to explain and measure, but the bottom line is that several tens of thousands of previously on-exchange Silver enrollees moved from on-exchange to off-exchange plans. If these folks hadn’t done so at the express urging of Covered California (as well as the exchanges in Maryland and Vermont, for that matter), most of them would be “counted” as exchange-based enrollees instead.
Fair enough. Enrollment came surprisingly close to last year even without all of the hand-holding from the Obama administration. But as small as the decline is, it must be put in some perspective. Obamacare enrollment has been a huge disappointment compared to what CBO projected over the years, as this chart demonstrates:
Next year, the repeal of the individual mandate means that there will be no penalty for not enrolling. Maybe Obamacare can buck the trend again, after all, it seems to have done so this year (albeit modestly). But it’s also possible that next year is the year we see more insurers back away and leave some parts of the country with no coverage options. But for now, Obamacare trudges on thanks mostly to those generous subsidies and the enrollees who are growing increasingly comfortable with having the taxpayers cover most of the cost of their health insurance.